NOTICE TO COUNSEL: To enable judges and magistrate judges of the court to evaluate possible disqualification or recusal, counsel for a private (non-governmental) business, company, or corporation shall submit at the time of initial pleading this statement of corporate affiliations and financial interest. IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF WISCONSIN ___________________________________ Case No. ______________________ v. ___________________________________ DISCLOSURE OF CORPORATE AFFILIATIONS AND FINANCIAL INTEREST I, the undersigned counsel of record for ______________________________________, make the following disclosure: 1. Is said party a subsidiary or affiliate of a publicly owned corporation? YES NO If the answer is YES, list below and identify the parent corporation or affiliate and the relationship between it and the named party: ________________________________________________________________________ 2. Is there a publicly owned corporation, not a party to this case, that has a financial interest in the outcome? YES NO If the answer is YES, list the identity of such corporation and the nature of the financial interest to the named party: ________________________________________________________________________ ____________________________________ Signature of Counsel 4/19/11 _______________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com